Systems and Methods for Customizing Product Selections Based on Member Parameters and Providing the Selections to Members for Purchase

ABSTRACT

The present disclosure relates to systems and methods for identifying at least one health plan option for an individual or employee, where the health plan option(s) identified have been selected based on the unique characteristics and profile of the individual or the unique characteristics and profile of the employee and format selections of the employer. The health plan option(s) identified may also be based on criteria provided by the individual or the employer, such as for instance, the amount of deductible and/or premium the individual is willing to pay, or for example, the health insurers the employer has selected to provide employee group coverage.

FIELD OF THE INVENTION

The present disclosure relates to systems and methods for assisting auser in procuring a health care product or insurance product. Morespecifically, the present disclosure relates to web-based systems andmethods for identifying at least one health plan option for anindividual or employee, where the health plan option(s) identified havebeen selected based on the unique characteristics, profile, and personalpreferences of the individual or employee. The health plan option(s)identified may also be based on criteria provided by the individual orthe employer, such as for instance, the amount of deductible and/orpremium the individual is willing to pay, or for example, the healthinsurers that the employer has selected to provide employee groupcoverage.

BACKGROUND OF THE INVENTION

The cost of health care in the United States is extraordinarily andnotoriously expensive. Many aspects of the U.S. health care systemcontribute to its expense. For example, some factors include: themixture of public and private payers; the lack of connection betweenwhat a typical insured person pays in premiums/deductible and/or co-paysand the services the person may receive; the enormous amount of medicalinnovation that occurs and the associated regulations for new drugsand/or devices; and the overall complexity of the system in general,which leads to administrative costs that continue to sky-rocket.

A large portion of the U.S. population has employer-based healthinsurance. An employer may offer health insurance as a benefit to itsemployees, and in some cases may ask the employee to contribute someamount per year for the employee's coverage. Often times the employermay select one or more plans its employees may choose from—typicallythis is a small number of plans, between 1 and 3, in many cases. Theprocess of selecting a health insurance carrier and specific plans maybe very complicated and time-consuming for the employer. Many times, allof the relevant information may not be available to the person or peopleat the company making the decision. Consequently, a company may end upwith a carrier and/or plans that are not cost-effective and that may notbe a good fit for some or all of the company's covered employees.

Other U.S. citizens may be unemployed—or employed by an employer thatdoes not offer health insurance—but may be ineligible to receive publicforms of health insurance, for example Medicare, Medicaid, or COBRA.Consequently, the individual must purchase health insurance individuallyon the market, if they want health insurance coverage at all. This maybe a daunting task for people unfamiliar with the complicated, heavilyregulated, and ever-changing world of health insurance. An individualmay wish to compare different products to determine the product that maybe best suited to the person's needs and situation but may not have thetime, information, knowledge, and/or means to research and compareavailable products.

Accordingly, a need exists in the art for an easy-to-use, intuitive,comprehensive system that may be used by employers/employees and/orindividuals in order to provide the user with at least one healthinsurance product that is selected based on the user's uniquepersonality, personal preferences, health profile, and/or financialprofile, whereby the user may choose to purchase one or more of theselected products.

BRIEF SUMMARY OF THE INVENTION

The present disclosure in one embodiment relates to a method foridentifying a product for purchase by an employee based on theemployee's circumstances and preferences. The method includes providinga secure web-based system that allows an employer of the employee toregister with the system. The method further allows the employer to makeformat selections related to a category of product that the employermakes available to the employee via the web-based system, wherein one ofthe format selections comprises the amount of money the employer willcommit to an employee account set up on the web-based system in orderfor the employee to purchase an identified product. The method alsoincludes allowing the employee of the employer to register with theweb-based system. The method further includes administering a survey viathe web-based system to the employee. The method also uses the resultsof the survey for the system to identify at least one product that meetcriteria of the employee as established by the results of the survey andthat meet criteria of the employer as established by the formatselections made by the employer. The method also provides permitting theemployee to select an identified product for purchase that may be paidfor by the system via the employee account or via a combination of fundsfrom the employee account and the employee's personal funds asappropriate.

In another embodiment of the present disclosure, a method is providedfor providing for purchase by an individual at least one health careproduct that has been specifically selected for the individual. Themethod includes administering a web-based survey to the individual, thesurvey providing questions related to at least one of the individual'spersonality profile, financial profile, or health status, wherein theresults of the survey are saved and stored in the web-based system. Themethod further includes using the results of the survey as input for theweb-based system to run a recommendation engine, wherein therecommendation engine selects at least one health care product for theindividual based on at least one attribute of the health care productmatching at least one result provided by the individual in response tothe survey. Also included in the method is paying for a health careproduct selected for purchase by the individual from funds deposited inthe account of the individual via the web-based system or theindividual's personal funds as appropriate.

In yet another embodiment of the present disclosure, a web-based systemis provided for providing at least one identified health insuranceproduct or service for purchase by an employee of an employer where theat least one product or service fits criteria provided by the employeeand the employer. The system includes a client format selection modulepermitting an employer to provide the system with format selections,including how much money to deposit into an employee account in orderfor the employee to purchase a health insurance product via the system.The system also includes an intelligent assessment survey module thatadministers a survey to the employee to determine the employee'spreferences and circumstances related to health insurance. The systemalso includes a recommendation engine module in communication with theintelligent assessment survey module configured to use results of thesurvey to provide the employee with at least one health insuranceproduct or service for purchase where the at least one identifiedproduct or service is based on the results provided by the employee inthe survey and format selections provided by the employer.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims particularly pointing outand distinctly claiming the subject matter that is regarded as formingthe various embodiments of the present disclosure, it is believed thatthe disclosure will be better understood from the following descriptiontaken in conjunction with the accompanying Figures, in which:

FIG. 1 is a diagram generally showing the process used to employ thesystems and methods of the present disclosure, according to oneembodiment.

FIG. 2 is a flow diagram illustrating some of the modules present insome embodiments of the present disclosure.

FIG. 3 shows the HIS system operating in a cloud computing environment,according to some embodiments of the present disclosure.

FIG. 4 provides some examples of parameters and associated tags used insome aspects of the present disclosure, according to one embodiment.

FIG. 5 shows a flow diagram describing the process used to employ thesystems and methods of the present disclosure, according to oneembodiment.

DETAILED DESCRIPTION

The present disclosure relates to novel and advantageous systems andmethods for identifying at least one health plan option for anindividual or employee, where the health plan option(s) identified havebeen selected based on the unique characteristics, profile and/orpersonal preferences of the individual or employee. The health planoption(s) identified may also be based on criteria provided by theindividual or the employer, such as for instance, the amount ofdeductible and/or premium the individual is willing to pay, or forexample, the health insurers the employer has selected to provideemployee group coverage.

More specifically, the present disclosure relates to web-based systemsand methods for matching individuals or employees—whose employers arepart of the system—with health insurance plan options that may beuniquely selected for the individual or employee and may accordingly bemore appropriate and cost-effective than prior art “one size fits all”methods of selecting and obtaining health insurance.

While specific embodiments and features of the present disclosure willbe provided in detail below, a general description of the presentdisclosure, in some embodiments, will now be provided. It will berecognized that the following general description may include some stepsor features that may not be included in some embodiments, while somesteps or features may be included in some embodiments that are notprovided in the following general description. For ease of explanation,the following general description will be provided with regard to anemployer and employee using the systems and methods of the presentdisclosure, but it should be understood that the description is notlimited to employer/employee clients.

Generally, a web-based system for providing health insurance and/orhealth care solutions may be provided. With reference to FIG. 1, theweb-based system may generally function as an on-line health insurancesuperstore (hereinafter referred to as “HIS”) 102. The HIS 102 may haveinitial clients and in some cases secondary clients. One example of anHIS 102 initial client may be a company 120, for example. The company120 may wish to provide its employees with health insurance and may haveelected to use the HIS 102 to accomplish this. The HIS 102 may providethe employer 120 with HIS 102 features, tools, and/or services to helpthe company determine how much money in pre-tax dollars, for example, toallocate to each of its employees for the purchase of health insurance.In some cases, this may be the same amount of money for each employee,while in other cases the amount of money allocated to each employee mayvary according to certain criteria that will be explained in greaterdetail below.

Once the employer 120 determines the amount of money to allocate foreach of its participating employees, the employer may commit pre-taxfunds equal to that amount into an account 130 for each of itsparticipating employees. The employee 140 may be considered a secondaryclient of the HIS. The employee 140 may have access to the HIS account130 via the HIS system web site. The employee 140 may access the securedon-line HIS system 102 in order to select a specific health insuranceplan that may be paid for out of the employee's account 130. In orderfor the HIS 102 to identify appropriate and optimal health insuranceplans for the employee 140, the HIS 102 may request that the employee140 complete a survey 152 generated by the HIS. In some embodiments, thesurvey 150 may be a comprehensive, intelligent and friendly health andfinancial assessment that may help the HIS 102 identify appropriatehealth plans and services for that employee 140.

The employee's 140 responses to the survey 150 may be used as inputsthat may be used in the HIS 102 recommendation engine module 180. TheHIS may also use the outputs of the survey 150 to provide a personalityprofile 185 via a personality profile module of the HIS. The employee140 may review the personality profile 187 and assess whether or notthey have been accurately characterized. If the employee 140 does notthink the personality profile accurately describes them, they may beasked by the HIS to retake some or all of the survey. The personalityprofile module of the HIS may generate a revised personality profilebased on the employee's new responses to the survey. If the employee 140agrees that the revised personality profile accurately describes them,the revised outputs from the survey may be used to run therecommendation engine 180 again. The recommendation engine 180 mayreturn as output, specific health care plans and/or services that matchor meet the parameters identified by the employee 140 in the survey 150.The health care plan options identified by the recommendation engine 180may then be provided to the employee 140 at the HIS 102 via a “virtualshelf” user interface 190 that may clearly and simply provide and/orexplain the uniquely identified health care plans and/or servicesidentified by the recommendation engine 180 for that employee 140.

The employee 140 may review the health care plan options and informationprovided by the virtual shelf module 190. The employee 140 may use theinformation provided to select a health care plan and/or service 194that best suits the employee. Payment for the selected plan may comefrom the employee's HIS account 130. In some cases, the employee 140 mayselect a plan that costs less than the amount of money in the employee'sHIS account. An employee may access the HIS 102 to shop for otheravailable products and/or services on which the employee may spend theremaining money. The HIS system may administer and oversee the entiretransaction.

As shown in FIG. 2, in some embodiments the HIS 102 system may comprisesome or all of the following modules: HIS system 210; client formatselection module 220; intelligent assessment survey module 230;recommendation engine module 240; personality profile module 250;virtual shelf module 260; payment and administration module 270; and/ormember services module 280. Each of these modules or components thereof,may include software or a portion thereof, hardware or a portionthereof, or a combination of software and hardware. It is also notedthat each module or component thereof may be combined or overlapped withor combined with modules or components performing other tasks in theprocess. In some embodiments, this overlap or combination may includetasks or steps adjacent to one another in a process, but in otherembodiments, the tasks and steps may not be adjacent one another.Moreover, any module or component thereof may or may not be included inthe system depending on the nature of the system desired. Additionally,the HIS system or any module or component thereof may include an inputand output module adapted to receive or send information from or to,respectively, other devices, modules, or components. As such, theseinput and output modules can include physical ports or connection to abus where the input or output module is of the hardware type. Othertypes of input and output hardware may be used. In the case of softwarebased input and output modules, these may include lines of code causinga processor to step or jump from one location to another or to anapplication programming interface, for example. Other types of softwarebased input and output may also be used.

With reference to FIG. 3, which will be described in greater detailbelow, in the case of a module where all or a portion of the module issoftware, the software may be located, for example, in the database 312for access by the HIS application server(s) 304, 306, 308. In otherembodiments, the HIS application server(s) 304, 306, 308 may include thesoftware. Those of skill in the art will understand and appreciate theseveral configurations available for using software, hardware, or acombination thereof to provide a module.

Each of the modules will be discussed in turn below under headingsreferenced in FIG. 2.

HIS System 210

The HIS system may include, in some embodiments: system components;member introduction components; and product components.

The system features of the HIS 102 system may include the general HISweb-based platform. In some embodiments, the HIS 102 may be a web-basedsystem that may be made available to clients or members over theinternet. In one embodiment, the web application may be developed usingGroovy, Grails, Linux and MySQL technology. The application may, in someembodiments, use the Grails scaffolding, for example. In otherembodiments, however, the web application may be developed using anyknown technology and/or computer language.

In some embodiments, the HIS may be run and offered via a cloudcomputing environment. Cloud computing generally refers tointernet-based computing, whereby shared resources, software andinformation may be provided to computers and other devices on-demand,similar to utility services, allowing for dynamically scalable and oftenvirtualized resources as a service over the internet. In some cases, forexample, a cloud computing provider may deliver the HIS system onlinesuch that it may be accessed from another web service or software suchas a web browser, while the software and data may be stored on servers.The cloud computing infrastructure may be delivered through data centersbuilt on servers. Cloud computing may typically involve cloud componentsthat communicate with each other over application programminginterfaces, usually web services.

With reference to FIG. 3, in some embodiments, the HIS may be providedvia a cloud-based computing system 300. The HIS application may bedesigned to run in a virtualized environment 302, for example Amazon'sEC2 platform. The virtualized environment 302 may host a plurality ofvirtual machines 304, 306, 308. In some cases, one or more machines 304,306, 308 may include a full Linux operating system (OS). In someembodiments, these operating systems may be running Tomcat, for example,as an application server. A load balancer 310 may also be included inthe system 300 such that the work load is efficiently and effectivelyspread across multiple application servers 304, 306, 308. In someembodiments, the load balancer may be a HAProxy load balancer. Thesystem may also include one or more databases 312 for safely andsecurely storing data. In some cases, the database may be a MySQLdatabase. While specific products and applications have been describedwith regard to the virtualized environment, application servers, loadbalancer and database, it will be understood that the use of alternativeproducts and applications is within the spirit and scope of the presentdisclosure.

A member may use a personal computer 316, 318, 320 to access the HISsystem via the internet 322. The web-based HIS system may be accessed byany number of members simultaneously via individual personal computers316, 318, 320. The HIS web-based system may be generally similar inconcept and structure to other well known and understood web-basedsystems, providing a user with user-friendly web pages and applications,for example.

Some pages of the HIS web site may be generally accessible to thepublic, such as, for instance, the home page, and other pages that mayprovide general information about the system. The site may also includeareas that are password protected or otherwise secured, so that membersor clients may provide and/or receive information, includingconfidential information, in a safe and secured manner. Any known methodof providing secured access to the web site or portions of the web sitemay be used.

In some embodiments, different modules, components, portions, features,or aspects of the HIS system 102 may be made available to usersdepending on the role or status the user may be associated with. Forinstance, a user may be designated as an administrator, product manager,member services representative, employer human resources representative,or a member, for example. The role associated with a user may limit orexpand the areas of the HIS system the user may have access to,depending on the security level assigned to the designated role.

The HIS system features may also comprise user-friendly interfaces. Forexample, user's who are designated as members may find the followingtabs, links, or pages, available to them on the HIS, for example, butnot limited to: “Create Your Account”; “All About Us”: “All About You”;“Your Options”; “Your Account.” The web site may also include links tolegal information that may be general and available for all users toreview or that may be tailored for users with different roles orstatuses. Legal information that may be provided on the site mayinclude, for example, but is not limited to: terms of use; terms ofservice; privacy policy; terms and disclaimers; data types collected anddisclosed; Health Insurance Portability and Accountability Act (HIPAA)information and requirements, and/or any other relevant or necessarylegal information.

In some embodiments, the HIS web site may include a member feedbackarea, a member ratings area, and/or a community area, for example. TheHIS may also provide any other member areas on the web site that mayprovide useful information and/or services for its members.

The HIS system may also comprise a member introduction feature. A newmember may, in some embodiments, receive an email, for example, that maydirect them to a URL and token to register on the HIS. In otherembodiments, the information may be provided by standard mail, or may bedelivered to an employee by their company, for example. In someembodiments, the first time a new user attempts to register with thesystem, the user may be directed to a feature on the site to assist theuser in registering and signing-in to the system as a member. In someembodiments, a welcome or orientation module may be presented to the newuser.

In some cases, the new user may be a company or employer who has decidedto use the HIS system to allow its employees to select health care plansindividually. There may be many users associated with the company oremployer with a variety of different roles. For example, the company mayhave a number of administrators and/or human resources representatives,for example, designated as company-level members. As discussed above,depending on the role of the member, each user or group of users mayhave different levels of access to modules, components or features ofthe HIS system. In other cases, the new user may be an employee of theemployer. While in still other cases, the new user may be an individualusing the HIS system to purchase health insurance directly from the HISsystem, i.e. not as an employee of a company using the HIS system.Depending on who the new user is, the new user orientation and/orwelcome may vary to provide information relevant to the type of useraccessing the system.

The HIS system may also include product features that may generallydefine the products and/or services the HIS may make available toclients or members. In some embodiments the products and/or services mayinclude all available plan types, and provide the brokering.

As discussed above, in one embodiment, the HIS may offerproducts/services directly to individuals, i.e. who may not be employedby an HIS member. In other embodiments, the HIS may provide products andservices to employers that may ask its employees to use the HIS systemto select a health insurance plan, for instance.

In some embodiments of employer-based embodiments, the HIS system mayallow employers to include only full-time employees in the HIS system.In other embodiments, the HIS may offer employers formats that mayinclude, or may also include, part-time employees. In some embodiments,the HIS system may offer employers formats that may include, or that mayalso include, former employees under, for example, a ConsolidatedOmnibus Budget Reconciliation Act (COBRA) alternative.

In some embodiments, the HIS may allow member companies to add newemployee members at any time during the month or year, for example. Inother embodiments, the employer may only be able to add new employees atpre-determined and specified times. In other embodiments, the HIS mayallow member companies to remove employee members at any time during themonth or year, or in other embodiments, employee members may only beremoved at pre-determined and specified times.

Once the employer has determined which employees may be participating inthe HIS system, the employer may be asked to provide the HIS with acensus file containing relevant employee information. Such informationmay include, but is not limited to: email; first and last name; date ofbirth; employer number; address; phone number; social security number;marital status; and date of hire. The employee information may beentered into the HIS system either automatically or manually, in someembodiments. In some embodiments, a company's human resourcesrepresentative may directly upload the census file, for example, in anExcel spreadsheet format, to the HIS system. In another embodiment, astandard 834 (benefits and enrollments form) that the company may haveon file for each employee may be, for example, uploaded to the HISsystem. Similarly, the company may upload, or otherwise provide the HISwith other relevant changes to an employee member's status, for example,whether a member employee's employment status changes, or marital statuschanges, for example.

The HIS may categorize different plan types according to the followingmarket segments, in some embodiments: defined contribution for a groupof more than fifty; defined contribution for a group of less than fifty;defined contribution for an individual; COBRA, for example. The HIS, insome embodiments may coordinate the underwriting process, which may beaffected by the market segment the member belongs to, which in turn mayaffect the health insurance plan or plans that may be available to themember.

The HIS, in some embodiments, may function as the broker of record fordirect sales of health insurance plans. In other embodiments, the HISmay partner with a third party broker in order to, for example, provideinformation to clients related to, for example, but not limited to:defining contribution strategy; conducting carrier selection/renewal;determining plan design; conducting open enrollment meetings; and/orproviding customer support and on-going value-added broker services. Insome embodiments, the HIS as broker or a third party broker may solicitquotes from health insurers or carriers and may also coordinateunderwriting for group coverage and/or individual coverage, for example.

While the HIS in some embodiments may coordinate underwriting, but notdirectly provide underwriting, a general description of the underwritingprocess is provided. Generally, medical insurance underwriting is aformal process through which major medical insurance companies evaluatethe risk of possible financial loss if coverage is extended to a singleindividual or group.

There are several risk factors that medical insurance companies mayconsider in their underwriting criteria for individuals such as age,health status and history, occupation, hobbies, risky behaviors, andlifestyle. Typically, an application that will be reviewed by theunderwriter may be completed.

Individual underwriting typically does not take place in the same wayfor those enrolled in group coverage, such as that through an employer,union, or association. Under a group policy, only a short applicationmay be completed that may include, for example, name, address, SocialSecurity number and whether there are any dependents that will also becovered. The insurance underwriter may consider the number of peoplecovered on the policy and the type of work being performed asunderwriting guidelines. Often, individuals joining an insured groupmust serve a probationary period before becoming eligible for coverageand then they may enroll during the eligibility period; often call “OpenEnrollment.”

If medical insurance is provided through an employer, COBRA coverage maybe available to an employee should employment end voluntarily orotherwise, provided the employer has twenty or more employees, accordingto current law. COBRA members may not be subject to individualunderwriting.

Client Format Selection Module 220

Once an initial member has registered with the system, the member maymake format selections by using the client format selection module ofthe HIS system. In some embodiments, the initial member may be anindividual not associated with a member company that wishes to purchasehealth care directly using the HIS. Such embodiments will be describedin greater detail further below.

In other embodiments, the initial member may be a company. The companymay make certain format selections, such as for example, but not limitedto, whether to extend coverage to full-time, part-time, and/or formeremployees. The company may also determine how much of a definedcontribution the company wishes to make to the account of eachparticipating employee. The amount of money allocated to each employeemay vary from employee to employee based on a number of factors. Inother embodiments, each employee may be allocated the same amount ofmoney. The company may utilize products and/or services provided by theHIS to help the company determine an appropriate amount of money toallocate to each employee or group of employees.

In some cases, an employer may choose to set up Health ReimbursementAccounts (HRA) for its employees via the HIS. HRAs are Internal RevenueService (IRS)-sanctioned programs that allow an employer to reimbursemedical expenses paid by participating employees, thus yielding taxadvantages to offset health care costs. The employer may allow for anycredit balance in an employee's account to be rolled over from year toyear like a savings account. The employer may also choose how much ofany balance rolls over, which can be either a flat amount or apercentage, for example.

With an HRA, employees may be reimbursed tax free for qualified medicalexpenses up to a maximum dollar amount for a coverage period, forexample, copays, coinsurance, deductibles and/or services. HRA dollarsmay generally be used to cover medical, dental, and vision expenses. Theemployer may determine what expenses that meet IRS 213(D) may beincluded in the HRA plan.

The HIS format may also include allowing the employer to set up employeeaccounts that are limited HRAs which may be used to pay or reimbursebenefits for permitted insurance and/or permitted coverage other thanlong-term care, and preventive care. In one embodiment of a limited HRA,the funds from the account may be limited by the employer and/or the HISto pay for reimbursement of individual health insurance policies forexample. Or the limited HRA may be limited such that if any moneyremains in the account after payment of or reimbursement for healthinsurance premiums, the employee may purchase additional productsavailable on the virtual shelf or use a reimbursement mechanism fordental, vision, and preventative care expenses, for example. In anotherembodiment of accounts that are limited HRAs, the limited HRA may beused to pay for health insurance premiums for a high deductible healthplan such that availability and eligibility to also use a health savingsaccount is preserved under the tax code. In such a case, the use of thelimited HRA may be limited to paying for premiums for high-deductibleplans.

In embodiments where an employer sets up HRAs for its employees via HIS,the HRA dollars may be allocated, for example, based on the coveragetier of the member employee. For example, coverage tiers may include:the employee only; the employee plus one; the employee plus family, forexample. Eligible dependents may be defined by the employer for groupsgreater than fifty, in some embodiments. For groups less than fifty,eligible dependents may be defined by the state, in some instances,while in other instances, for example, eligible dependents may bedefined within each product. In some embodiments, a cap on the amount ofmoney that may be in each HRA account may be determined by, for example,the employer, or the sponsor of the plan each individual purchases.

In other embodiments, an employer may choose to set up a WellnessEducation Account (WEA) as part of the employer selected format. WEAaccounts may be separate and different than an HRA, in some embodiments.A WEA plan may generally be in writing and operate much the same as anHRA, but may be subject to an annual limitation of, for example, $5,250.WEA funds, in some embodiments, may roll over from year to year.Education may be provided by the employer directly, in some embodiments,or may be provided in other embodiments, for example, by a third party.The education may include, in some embodiments, online, telephone,and/or in-person delivery methods. WEAs may be additionally subject tonon-discrimination requirements. In some embodiments, employers may onlyinclude current or former employees in a WEA plan. There may also be, insome embodiments, prohibitions on benefits for certain 5% owners, forexample. In some embodiments, WEA funds may be used for eligibledependents covered in a health insurance plan.

In some embodiments, employers may also select a Premium Only Plan (POP)or a Premium Reimbursement Account (PRA) that may allow the employee tobe reimbursed for premium payments paid with employee pre-tax dollarsthat are deducted from the employee's pay, if for example, an individualexhausts the funds in their HRA HIS. The HIS may, in some embodiments,calculate the payroll deduction amount and create a report for thecompany such that the company may appropriately adjust the employee'spay.

The HIS may, in some embodiments, be integrated with a member company'spayroll such that the HIS may automatically adjust a member employee'spay based on, for example, insurance premiums paid via a POP that may beserviced by the HIS.

The HIS may offer an employer one or more standard plans, for example.In one embodiment, a standard plan may include an employer setting upHRA HIS accounts for each participating employee. The employee may usethe funds in the HIS account to purchase, for example, insuranceproducts and/or IRS 213D eligible products. A standard plan may alsoinclude, for example, a WEA that may be used separately from an HRA, forexample, and may be used to pay for educational or activity programs.For example, in some embodiments, the programs may include nutritionprograms, nutrition tracking programs, general health monitoringprograms, fitness log and advisor, or any other suitable health andwellness oriented program. In such an embodiment, for example, the HRAHIS account may function substantially similarly to the WEA HIS account.

In one embodiment, a standard plan may only include the HRA HIS account,while in other embodiments, a standard plan may include a WEA HISaccount, or in other embodiments, a standard plan may include both anHRA and a WEA HIS account.

In some embodiments, the company may also choose certain options withregard to mid-year hires. For example, whether the mid-year hirereceives a direct contribution equal to the amount for the full year, orwhether the mid-year hire receives a pro-rated portion of the fullyear's direct contribution. Contributions may be pro-rated in someembodiments depending on the month the employee was hired, for example,or in other embodiments, at the beginning of a fiscal quarter. In stillother embodiments, pro-rating may be done by any reasonable method.

Similarly, in some embodiments, an employer may choose options relatedto employees whose tier status changes during the year. For example, amarried employee may have a child during the year and accordingly theemployee's tier status may change from employee plus one to employeeplus family, for example. The company may choose whether the HRA and/orWEA contribution amount may be increased to the full amount of the newcoverage tier less payments already paid, for example, or whether theHRA and/or WEA contribution amount may be increased on a pro ratedbasis, for example. A decrease in coverage resulting from a change inemployee tier status, in some embodiments, may not result in a decreasein HRA or WEA HIS dollars for the year.

Further, in some embodiments, a company may choose the amount of time,for example, a number of days, or through the plan year, that the fundsin an HIS HRA and/or WEA account may be held for an employee for them toreturn to the same account balance, for example when an employee leavesthe member company.

The HIS and/or the company may also make available to members, productsother than those discussed above, in some embodiments. For example, someor all of the following options may be made available to some or allmembers: vision; life insurance; voluntary life insurance; short-termdisability; long-term disability; business travel accident; accidentaldeath and dismemberment; flexible spending accounts (which may includetransit, medical, and/or dependent care); health savings accounts;and/or long term care, and/or any other ancillary benefit. Whileembodiments described herein are described and explained with regard tohealth insurance and/or wellness products, it will be recognized thatthe HIS system may be used in a substantially similar manner to providea member product options from the aforementioned categories as well.

The company's selections and choices may be entered and stored in theHIS. Once the company has made all of the required and/or availableformatting decisions as described above, the company may instruct itsparticipating employees to access the HIS system. The employee membermay register with and/or be welcomed to the HIS as described above.

Intelligent Assessment Survey Module 230

The HIS, in some embodiments, may include an intelligent assesmentsurvey module that may be used to administer to the newly registeredemployee, an intelligent assessment survey (IA). The IA may be a surveythat includes a plurality of questions. The questions may be of any formand/or format, for example, but not limited to, fill in the blank, shortanswer, multiple choice, true or false, rating/ranking and/or any otherform or format of questioning. The IA may have any suitable number ofquestions, for example, in some embodiments, the IA may haveapproximately thirty questions. It will be understood, however, that theIA may have any number of questions greater or less than thirty. In someembodiments, the questions may be asked in a fun, engaging way. Thequestions may be directed to the employee member's health, behavior,personality, and/or financial situation, for example. In someembodiments, the questions asked may vary depending on the attributes ofthe member employee, for example, but not limited to the age, gender,and general over-all health of the member. Column A of FIG. 4 providessome examples of categories of questions that may be asked about in theIA.

The IA may be administered on-line in the HIS, in some embodiments. Inother embodiments, the IA may be a paper and pencil survey that may bemailed to the HIS by the employee or the company for input into the HISsystem.

Recommendation Engine Module 240

The member's responses to the IA may be used by the HIS to run therecommendation engine module. For example, in some embodiments, similarto the way the PP module works with the IA, which is described in detailbelow, each response to the IA may be assigned a dimension and taggedwith a label such that the member's preferences and needs may be matchedmost appropriately with the eligible products offered by the HIS.Examples of labels that may tag a particular dimension are provided inColumns A and B of FIG. 4. In some embodiments, each IA responseprovided may have one or more tags associated with it that may describethe response for purposes of use with the recommendation engine module.In some cases, the tags associated with IA responses for use with the PPmodule may be the same as tags associated with the same IA responses foruse with the recommendation engine. In other cases, a single responsemay have one tag associated with it for use with the PP module, andanother tag associated with it for use with the recommendation enginemodule.

Each eligible health care product may also have one or more tagsassociated with it that describe the product with regard to a particulardimension. For example, a product may have tags associated with it asfollows: risk-low; smoke-yes; finance-high. The recommendation enginemay provide product options for the member by sorting the products bythe number of tags that match between the member's responses and thetags associated with the product, for example. For example, in someembodiments, products with the tag that occurred most often in theuser's responses may be sorted above those that do not have that tag. Ifmore than one available product has that tag, the recommendation enginemay look at the member's second most selected tag and so on through thelist of the member's remaining tags. If there are no more tags toreview, but a product has not been found to be a best match for amember, the recommendation engine may sort on the price, sorting, forexample, lower priced products before higher priced products.

The recommendation engine advantageously may only select those productsthat are 1) available to the employee for purchase (based on, forexample, the employer's format selections), and 2) best suited to thepersonal preferences and other attributes of the employee as identifiedby the IA. Accordingly, an employee is unlikely to purchase a plan thatis not well-suited and cost-effective for them. For example, a personthat is generally considered “risk-low” may not be best servedpurchasing a product that is generally a “risk-high” product. Therecommendation engine module, in conjunction with the virtual shelfmodule, help the client choose among the best products available to thembased on their own personal preferences and attributes as determined bythe IA.

In some embodiments, the recommendation engine may provide as output oneor more personalized options for the member to purchase, including, forexample, health care insurance and/or wellness education products and/orservices.

Personality Profile Module 250

In some embodiments, the HIS may provide the member with a healthcarepersonality profile (PP) via the system's personality profile module.The personality profile may comprise an individualized report that maybe a summary of the member's unique health personality. The PP may becompiled by the HIS using information provided by the member in the IA.Each of the questions in the IA may have several possible responses (forexample as in a multiple choice or true/false formats). Each of thepossible responses may have one or more tags associated with eachresponse that may be different from the tags assigned to the otherpossible responses. For example, a question may ask, “how likely are youto sky-dive in the future?” The possible responses may include: a) thereis no way I am ever going sky-diving, b) I would not rule it out, or c)I have a standing monthly appointment at the air field. In this caseresponse “a” may have a “risk-low” tag associated with it; response “b”may have a “risk-mid” tag associated with it; and response “c” may havea “risk-high” tag associated with it. Similarly, each personalitystatement associated with the PP and stored in the HIS may also have oneor more tags associated with it, for example, “risk-low,” “risk-mid,” or“risk-high.” For example, one of the personality statements stored inthe HIS's PP module may be the following: “you are an adventurous personwho likes to try new things including exhilarating activities thatremind you that you are alive.” This PP statement may be associated withthe “risk-high” tag.

After a member completes the IA, the HIS system may sum up all of thetags associated with the responses the member has provided and thenumber of occurrences of each type of tag. Personality statementsassociated with the tags that occurred most often in the user'sresponses may be sorted above personality statements that do not havethat tag. In the example provided, the hypothetical respondent providedat least one response associated with the “risk-high” tag. If, forexample, the hypothetical respondent also selected additional responseswith the “risk-high” tag, the HIS may select the personality statementthat is also associated with the “risk-high” tag to summarize thepersonality type of the respondent. A maximum number of personalitystatements may be provided in the member's PP, for example, fourstatements, or any other number of statements.

In some embodiments, the member may be asked to confirm the accuracy ofthe PP. In some cases, if the member does not agree with the PP, the HISmay alter the recommendation engine inputs of the member to conform tothe member's feedback regarding the PP. In such a case, the member maybe asked to confirm the accuracy of a second, updated PP. If the memberconfirms the accuracy, the recommendation engine may use the responsesfrom the altered IA to generate a list of products for the employee toconsider for purchase. In some embodiments, the member may also retakethe IA in order to change their previously entered responses to betterconform to their circumstances and/or preferences.

Virtual Shelf Module 260

The output of the recommendation engine may be used to provide productson the HIS virtual shelf for the member via the virtual shelf module. Insome embodiments, one or more products on the virtual shelf may be ahealth insurance plan. The virtual shelf may display and explain each ofthe products. For instance, for a health care plan offered on thevirtual shelf, the member may be provided with the plan's associateddeductibles, riders (e.g. preventative, network, smoking status,prescription coverage), coverage tiers, age bands, prices, or any otherfactors that may be associated with the product. The employee may beable to select the carrier/offering/product of their choice from thevirtual shelf for purchase.

In some embodiments, the virtual shelf may also include wellnesseducation programs and/or services. For example, some of the programsoffered may include, online nutrition programs, online food trackingprograms, online activity programs, smoking cessation programs, diseasemanagement programs, and/or other wellness services. In someembodiments, the wellness products may be free, or they may cost someamount of money, or may include a mixture of both.

Payment and Administration Module 270

Once the member has selected one or more products for purchase, the HISmay be used to pay for the product and/or service with the funds thathave been allocated to the member's HIS account via the payment andadministration module. If, for example, the HIS account is an HRA or aWEA account, the HIS system may automatically transfer the correctamount of funds from the sponsor account or accounts to the serviceprovider. In other embodiments, the employee may make the paymentdirectly, but may be reimbursed by the HIS system with funds from themember's HIS account. In some embodiments, the HIS may make a payment toa partner that may cover one or more employees, drawing on funds fromone or more accounts. Any payment adjustments that may be made to amember's account may be managed either automatically or manually by HIS,in some embodiments. Any necessary reconciliation and/or adjustment thatmay need to be made to a member's account may be made at any appropriatetime, for example, but not limited to, the following month.

In some embodiments, the HIS and/or the employer may contract with athird party to provide claim adjudication, account management, andpayment card services, for example.

Member Services Module 280

The HIS system may also comprise a member services module. The memberservices module may be accessible via a tab, for example, on the HIS website. Some examples of member services that may be available in someembodiments, include, but are not limited to: web site support(including, for example, login issues, navigation, community and messageboards, and/or general help); assistance with the member's HIS account(including, for example, balance inquiries, transaction inquiries,payroll deduction issues and questions, and/or member data updates);assistance with completing the IA; assistance with virtual shelfpurchases (including, for example, features and pricing, paymentprocess, accessing services on vendor sites, and/or returns andrefunds); ranking virtual shelf products and services; connecting tovirtual shelf vendors' customer services as appropriate; and/or triageto health insurance enrollment support, licensed representatives or totier two customer service support for complex account administrativequestions, for example.

In some embodiments, the HIS system may provide the member services,while in other embodiments member services may be provided by the HISand/or plan sponsors, for example. Member services may be provided byany known means, including, but not limited to, telephone, email,in-person, mail, text, live-chat, and/or any other method forcommunicating with a member, or providing information to a member orprospective and/or past member. In some cases, licensed representativesof the HIS may specifically respond to health insurance questions thatthe member may have. The HIS may track all customer interactions withmembers, in some embodiments, for documentation and/or evaluationpurposes, for example.

Member services may also include insurance enrollment support forinitial selection and/or after a selection has been made, in someembodiments. For example, in some embodiments, member services mayinclude, but are not limited to the following: general health insuranceeducation/assistance (including, for example plan types, financialconsideration (e.g. deductibles, co-insurance, co-pay)), coverageconsiderations (e.g. preventative care, conditions covered, prescriptioncoverage); understanding health insurance options made available by theemployer (if applicable); understanding available employer contributiontiers (e.g. single, family, opt out, etc.); support for qualifyingevents (coverage changes, employer contribution adjustments, COBRAprocess); connect to a health plan's support center; information on theappeals process for virtual shelf insurance vendors; and/or support formember grievances.

In addition to the member services described, the HIS may also includethe following member services directed generally to helping a memberunderstand the products recommended by the HIS, for example, but notlimited to: factors used in the recommendation engine; benefits ofchoosing recommended products; and/or purchasing products outside therecommended set. In some embodiments, the following member services maybe offered generally relating to assisting the member with virtual shelfpurchases, for example, but not limited to: features and pricing;payment process; accessing services on vendor sites; ranking virtualshelf products; and/or returns and refunds. In further embodiments,member services may include, or may also include, services directed tohelping a member make a health plan decision and/or the health insuranceenrollment process, including, for example: completing the healthinsurance enrollment application; payroll deduction set up; and/or othermethod of payment set up (e.g. credit card, direct deposit, etc.). Itwill be recognized that still other member services may be included inthe HIS in order to assist HIS members, prospective members and/orformer members with their health care needs.

In some embodiments, the HIS may also comprise an evaluation process todetermine whether a commercially available product, or a specificallydesigned product has sufficient quality and philosophical fit with theHIS system. For example, in some embodiments, the HIS may only considervendors that have a relatively high commitment to continuously reviewingand incorporating member feedback into their service/product design,and/or vendors that are willing to share quality assurance processes andmake adjustments as needed to match minimum standards as defined by HIS,and/or vendors that are willing to price products and/or servicescompetitively on the Virtual Shelf, for example.

While the embodiments described above were described with regard to anemployer/employee member, other embodiments of the present disclosureare possible. For example, in one embodiment an individual may access,register with, and use the HIS system in substantially the same way asdescribed above, in order to purchase health care products and/orservices and/or ancillary products and/or services directly. Anindividual may generally follow the same steps as outlined above and thesystem may function substantially similarly through to the point wherethe individual selects a product from the virtual shelf. For example, asshown in FIG. 5, an individual may access the HIS system 510, completethe IA 520, and review results on the Virtual Shelf provided by the HISrecommendation engine 530.

At this point, when the individual selects a product for purchase fromthe virtual shelf 540, the individual may be requested to complete anapplication form 550. There may not be a universal form for individuals,but instead, each carrier, and sometimes each product may have a uniqueapplication process. The HIS may identify and provide the member withthe appropriate application form based on the product the memberselected. The form may be provided as a PDF to complete online, or itmay be emailed, mailed, or faxed, for example, to the individual member.In some embodiments, the HIS may pre-populate known fields of theapplication form via the HIS database. For example, the broker, billingaddress, product chosen, and/or member demographics, for example, may becompleted by the HIS system. The HIS may also complete any additionalforms the carrier may require, in order to create, for example, an autopay process. The form may be completed and submitted to the HIS, whichmay then submit the member application to the designated carrier withthe initial payment. The initial payment may be taken from theindividual's HIS account, into which the individual may directly depositfunds.

The member and the HIS may be notified of the carrier's decision aftersome period of time, for example, one-four weeks. Approval/denialcriteria and/or the timeframe for notification may vary by carrier. Ifthe carrier denies the member coverage, the HIS may help the memberidentify and/or navigate any programs available for that member 560. Forexample, in Minnesota MCHA exists to offer policies for individualhealth insurance to Minnesota residents who have been turned down forhealth insurance by the private market, due to pre-existing healthconditions. MCHA is sometimes referred to as Minnesota's “high riskpool” for health insurance or health insurance of last resort.

If, however, the carrier approves coverage of the member, HIS may verifythe effective date of coverage, the rate of coverage, and/or plan andmake adjustments as necessary for payment via the member's HIS account,for example 570. In some embodiments, this may be done by payrolldeduction from the member's paycheck to the member's HIS account. Inthis event, the HIS may also create employer reports to communicate suchdeductions and product choices, in some embodiments.

In the foregoing description various embodiments of the invention havebeen presented for the purpose of illustration and description. They arenot intended to be exhaustive or to limit the invention to the preciseform disclosed. Obvious modifications or variations are possible inlight of the above teachings. The embodiments were chosen and describedto provide the best illustration of the principals of the invention andits practical application, and to enable one of ordinary skill in theart to utilize the invention in various embodiments and with variousmodifications as are suited to the particular use contemplated. All suchmodifications and variations are within the scope of the invention asdetermined by the appended claims when interpreted in accordance withthe breadth they are fairly, legally, and equitably entitled.

1. A method for identifying a product for purchase by an employee basedon the employee's circumstances and preferences, the method comprising:providing a secure web-based system that allows an employer of theemployee to register with the system; allowing the employer to makeformat selections related to a category of product that the employermakes available to the employee via the web-based system, wherein one ofthe format selections comprises the amount of money the employer willcommit to an employee account set up on the web-based system in orderfor the employee to purchase an identified product; allowing theemployee of the employer to register with the web-based system;administering a survey via the web-based system to the employee; usingthe results of the survey for the system to identify at least oneproduct that meet criteria of the employee as established by the resultsof the survey and that meet criteria of the employer as established bythe format selections made by the employer; and permitting the employeeto select an identified product for purchase that is paid for by thesystem via the employee account.
 2. The method of claim 1, furthercomprising providing the employee with a personality profile accessiblevia the system and that is generated using the results of the survey. 3.The method of claim 1, wherein the category of product that the employermakes available to the employee via the web-based system is a healthinsurance product.
 4. The method of claim 3, wherein the employeeaccount is set up as a health reimbursement account or limited healthreimbursement account.
 5. The method of claim 3, further comprisingcoordinating underwriting based on format selections made by theemployer.
 6. The method of claim 3, further comprising brokering directsales of the health insurance product to the employee.
 7. The method ofclaim 3, wherein the survey includes questions related to the employee'shealth, behavior, personality, and financial situation.
 8. The method ofclaim 1, wherein the category of product that the employer makesavailable to the employee via the web-based system is a wellnesseducation product or service.
 9. The method of claim 1, wherein thecategory of product that the employer makes available to the employeevia the web-based system is a vision product or service, life insuranceproduct or service, short-term disability product or service, long-termdisability product or service, business travel accident product orservice, accidental death and dismemberment product or service, flexiblespending account product or service, health savings account product orservice, or long term care product or service.
 10. The method of claim1, further comprising allowing the employee to purchase additionalproducts or services via the system if the employee has funds left overin their account after payment is made by the system for the product theemployee selected for purchase.
 11. The method of claim 1, furthercomprising providing a member area on the web-based system that allowsemployers and employees to at least one of provide feedback on thesystem, and rate the service of the system or product.
 12. The method ofclaim 1, further comprising receiving information about the employeefrom the employer for input into the system.
 13. A method for providingfor purchase by an individual at least one health care product that hasbeen specifically selected for the individual, the method comprising:administering a web-based survey to the individual, the survey providingquestions related to at least one of the individual's personalityprofile, financial profile, or health status, wherein the results of thesurvey are saved and stored in the web based system; using the resultsof the survey as input for the web-based system to run a recommendationengine, wherein the recommendation engine selects at least one healthcare product for the individual based on at least one attribute of thehealth care product matching at least one result provided by theindividual in response to the survey; paying for a health care productselected for purchase by the individual from at least one of fundsdeposited in the account of the individual or the individual's personalfunds via the web-based system.
 14. The method of claim 13, furthercomprising providing the individual with an application form to becompleted by the individual based on the health care product theindividual selects for purchase.
 15. A web-based system for providing atleast one identified health insurance product or service for purchase byan employee of an employer where the at least one product or servicefits criteria provided by the employee and the employer, the systemcomprising: a client format selection module permitting an employer toprovide the system with format selections, including how much money todeposit into an employee account in order for the employee to purchase ahealth insurance product via the system; an intelligent assessmentsurvey module that administers a survey to the employee to determine theemployee's preferences and circumstances related to health insurance;and a recommendation engine module in communication with the intelligentassessment survey module configured to use results of the survey toprovide the employee with at least one health insurance product orservice for purchase where the at least one identified product orservice is based on the results provided by the employee in the surveyand format selections provided by the employer.
 16. The system of claim15, further comprising a virtual shelf module in communication with therecommendation engine module, the virtual shelf module configured toprovide the employee with the at least one identified health insuranceproduct or service via a web-based application.
 17. The system of claim15, further comprising a personality profile module in communicationwith the intelligent assessment survey module, the personality profilemodule configured to provide the employee with a unique healthpersonality profile using the results of the survey via a web-basedapplication.
 18. The system of claim 15, further comprising a paymentand administration module configured to allow the system to pay for theemployee's purchased health insurance product via at least one of theemployee's account or the employee's personal funds.
 19. The system ofclaim 15, further comprising a member services module.
 20. The system ofclaim 15, wherein the system is provided via a cloud computingenvironment.
 21. The system of claim 15, wherein the intelligentassessment includes about 20 questions.
 22. The system of claim 15,wherein the intelligent assessment includes about 30 questions.
 23. Thesystem of claim 15, wherein the intelligent assessment includes fromabout 40 questions to about 50 questions.